China lacked a ‘zero Covid’ exit plan. Its people are paying the price

HONG KONG/SHANGHAI: At the public hospital in Shanghai where Nora, a 30-year-old doctor, works, tensions have risen since China eased its strict no-Covid policy on December 7.
Patients argue with doctors over access to scarce drugs, such as cough and pain relievers. Medical overload; Infected employees continue to work because of staff shortages.
“Policy of Control” covid was relaxed very suddenly,” said Nora, who did not give his full name because of the sensitivity of the matter. “Hospitals should have been notified in advance to fully prepare.”
After years of taking harsh measures to stamp out the coronavirus, President Xi JinpingThe sudden abandonment of the Covid-free rule in the face of widespread protests and outbreaks has left China struggling to prevent the collapse of its public health system.
Shortages of drugs and testing kits as well as logistical disruptions are upsetting daily life. Four hospital workers told Reuters that inadequate planning for a Covid-free end had left them struggling to reopen amid chaos.
Kenji Shibuya, a former senior adviser to China, said: “I think China thinks its policy has been successful and that a gradual transition to the epidemic phase is possible, but that is clearly not the case.” . World Health Organization.
More than a dozen global health experts, epidemiologists, residents and political analysts interviewed by Reuters identified the failure to vaccinate the elderly and communicated the exit strategy to the public, as well as excessive focus on eliminating the virus, which is a source of tension for China. medical infrastructure.
These people said the country has spent a lot of money on quarantine and testing facilities over the past three years instead of consolidating hospitals, clinics and training medical staff.
“There is no transition period for the health system to prepare for this,” said Zuofeng Zhang, a professor of epidemiology at the University of California, Los Angeles. “If they can dedicate a small portion of (used) resources to Covid-19 testing and blockade, then China will be better off in this policy change.”
China’s National Health Commission did not respond to requests for comment on the resilience of the health system and the provision of medical staff; whether there is a contingency plan in place to deal with the spike in hospitalizations; and whether strict coronavirus measures hinder the improvement of medical capacity.
State media have defended Beijing’s approach while rewriting their message to emphasize the softer nature of the Omicron variant. In reviewing China’s Covid-19 response, the official Xinhua news agency on December 9 said Xi had “done the right thing” by taking “resolute actions to prevent the spread of the virus”. of viruses”.
official data
As the outbreak unfolds, official data on severe cases and mortality can hardly reflect the situation, experts including Mike Ryan, WHO’s emergency director, said. In Beijing, funeral homes and crematoriums are struggling to keep up with demand.
The National Health Commission has reported only a handful of Covid-related deaths since reopening, bringing China’s total official pandemic deaths to 5,241, very low compared to with global standards.
Meanwhile, an effort to vaccinate the elderly, which began three weeks ago, has yet to bear fruit. According to government data, China’s overall vaccination rate is above 90%, but the proportion of adults who have received booster shots falls to 57.9% and 42.3% for people 80 years of age and older.
China has refused to launch Western-made mRNA vaccines, which studies show are more effective than domestically produced ones. More than a dozen experts say failure to increase vaccination rates for vulnerable people could jeopardize China’s health system.
Hiroshi Nishiura, a member of Japan’s COVID task force, said: “As we have seen in Hong Kong, unvaccinated older people have a particularly high risk of death and perhaps the possibility of death. Healthcare in China will soon be overwhelmed by the load demand.”
Discontent over China’s frequent shutdowns and strict pandemic restrictions peaked in November when protests broke out across the country. Within days, Beijing announced a sudden relaxation of Covid-free rules.
Since then, smaller protests have occurred at medical schools, with some students working on the front lines demanding better protection and medical supplies. The death of a 23-year-old medical student in Chengdu on December 14 sparked public outrage at the strain on China’s health system.
“We are the last people in the food chain at the hospital,” said a 26-year-old medical student in northern China. “If we’re on the front lines, we don’t have enough protection for ourselves: we’re even required to reuse masks.”
slow investment
China’s Covid-free mandate increases the pressure on hospitals and medical staff due to a centralized health system, with people being hospitalized even if they have mild symptoms. The government only started allowing home quarantine on December 7.
While China’s Centers for Disease Control and Prevention has repeatedly warned that a large-scale outbreak would have a devastating impact on the health system, trying to stamp out the virus has strained the health system. medical resources.
Some experts like Hong TieuZero-Covid has proved costly and dangerous to public health, moving funds and healthcare workers to the front lines of the pandemic and preventing it, said a researcher at the Fred Hutchinson Cancer Research Center in Seattle. prevent patients with other diseases from being treated.
Other researchers say the current threat to China’s health care system has been exaggerated.
Chen Jiming, a researcher at China’s Foshan University, said China’s health system could cope once the country had ended its quarantine for mild and asymptomatic cases.
“Now, I think China can mitigate the impending tsunami of COVID-19,” he said. “Certainly, the health system is under a lot of pressure these days, but I think the government can manage it.”
However, official data shows that China’s investment in medical resources such as hospital beds and the growth rate of medical workers have slowed during the pandemic. Although overall health spending increased from 2019 to 2021, it fell slightly relative to GDP for the first time in more than six years, to 6.5% last year from 7.1 % in 2020 and 6.6% in 2019.
It’s not clear how much it would cost to build quarantine facilities or provide tests, but analyst estimates collected by Reuters in May show China’s planned COVID-related spending. Country this year is about 52 billion USD.
Faced with a surge in infections, authorities have been trying to catch up. According to a Reuters review, local government tenders to buy ventilators and patient monitors have skyrocketed. There were 423 ventilator tenders announced between November 15 and December 15, up from 283 in the previous period and 200 before.
Even as the government has changed its message urging people to stay home unless seriously ill, patients are still flocking to hospitals and clinics after three years of government propaganda about the dangers of the virus.
In Tianmen, a small city near Wuhan, infected patients were camped outside clinics as they received intravenous infusions, according to a resident who shared pictures with Reuters.
In Hanchuan, Hubei province, patients sat in their cars to receive IV fluids through car windows, December 14 footage obtained by Reuters showed.
In some cities, the lack of clear guidance on what to expect when someone gets infected has added to the chaos.
At a public hospital in Beijing, a senior doctor said all surgeries had been canceled except for the case that the patient was likely to die the next day.
“Up to 80% of doctors at top hospitals in Beijing are infected with the virus but are forced to continue working,” he told Reuters on condition of anonymity because he was not authorized to speak to the media.
According to the World Health Organization, China has about 2 doctors per 1,000 people, compared with 4.3 in Germany and 5.8 in the UK. And it has 3.6 intensive care beds per 100,000 people, compared with 34.7 in the United States, 29.2 in Germany and 12.5 in Italy, World Population Journal data shows.
There is no route
China has other imperatives to pursue a strict Covid-free approach this year, given the threat of a major outbreak that could trigger significant events. Before the Beijing Winter Olympics in February, the government tightened control of the pandemic and state media warned of the dangers of the virus.
On the eve of the Communist Party congress in October, where Xi is looking to consolidate his power with a third term, authorities insist that it is impossible to deviate from Covid zero despite the losses. economic damage and warned of the risks of reopening.
“Once the disease prevention and control work is relaxed, a large number of people will be infected in a short time, a large number of serious cases and deaths will occur, leading to a exhausted medical resources,” the party’s People’s Daily said. the official newspaper, said in an October 12 commentary calling for sticking to zero-Covid.
As Xi tightens his grip on power and focuses on stamping out the virus at any cost, the leadership has not offered any blueprint for how China will get around the severe restrictions.
As infections have begun to skyrocket in recent weeks, it has become clear that the virus has overcome COVID’s zero defenses.
But Mr. Xi’s abrupt turnaround means that many companies are not prepared with sick leave policies or protective gear, while many ordinary Chinese, unaccustomed to COVID treatment at home, have been overwhelmed. pharmacies to find cold and flu medicine.
Some cities said workers with mild symptoms could continue to go to work, local media reported, adding to the confusion. A hospital in Shanghai told its staff this week to prepare for a “tragic battle”.
At least 10 health experts who spoke to Reuters said they expect the number of infections to peak in the next one to two months, around the Lunar New Year holiday that begins on January 21.
Keith Neal, professor emeritus of infectious disease epidemiology at the University of Nottingham, said a wave of deaths similar to those experienced by Hong Kong earlier this year was “a good sign of what could be.” out” in mainland China.
“The main challenge will be a large number of serious infections and deaths in a vulnerable population because they are not infected or not vaccinated,” he said.
The US-based Institute for Health Metrics and Evaluation, part of the University of Washington, said last week it expected more than 1 million deaths through 2023 as a result of China’s sudden outbreak. abrupt lifting of restrictions on Covid-19.
At the hospital in Shanghai, Nora said new infections were on the rise, although the hospital did not make the data public. Doctors worry about infecting patients and loved ones.
“The hospital doesn’t have a perfect plan to deal with all the problems and policies are changing on a daily basis,” she said.


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